1 – NON-GOVERNMENTAL ORGANISATION "CENTRE FOR ASSISTANCE AND COMPENSATION FOR LOSSES CAUSED BY RUSSIA'S AGGRESSION" IN PARTNERSHIP WITH NGO “VICTIMS OF WAR IN UKRAINE”

Full Name *

Att.: NGO "CENTER FOR ASSISTANCE AND COMPENSATION FOR LOSSES

CAUSED BY RUSSIAN AGGRESSION" (the “NGO”)

APPLICATION
to join the NGO and to get the protection of violated rights and interests resulting from russian aggression

I, {name-1},kindly ask to admit me as an associate member of the NGO in order to get the protection of my violated rights and interests, in particular, to file a claim for compensation of damages (losses and/or moral harm) against the state of the russian federation, and any other parties involved in the russian military aggression, including state and private companies, sanctioned persons, etc.

I have read the Articles of Association, published on the website http://ukrainewar.claims/en/ ("Website") ознайомився(-лася).

In order to get the protection of my violated rights and interests, I hereby authorise the NGO and any lawyers engaged thereby to represent and protect my rights and interests in Ukraine and abroad before public authorities, courts, law enforcement agencies, local governments, enterprises, institutions and organisations of all forms of ownership and subordination, and to enjoy all procedural rights and obligations that would be granted to me if I were to file a claim in person, and I do understand the consequences of filing a claim in my interests.

I hereby consent to the processing of my personal data provided to the NGO in accordance with the Law of Ukraine "On Personal Data Protection" for an unlimited period of time and without restrictions as to the territory, in particular, when filing a claim, enforcing a court decision both in Ukraine and abroad.

Date

Day

Month

Year

Personal signature *

Contact phone number *

Attachment:

1. NGO Member Application Form.

Note:

The application, form, and attached documents can be sent to the NGO's email address info@ukrainewar.claims, downloaded or filled online at http://ukrainewar.claims/en/, or sent via a convenient messenger (Telegram, WhatsApp, Viber) to the phone number +380 (68) 385 30 14.

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NGO "CENTER FOR ASSISTANCE AND COMPENSATION FOR LOSSES CAUSED BY RUSSIAN AGGRESSION"
Associate Member Form

Passport (national ID): series (if any), number, authority and date of issue *

Tax ID *

Place of permanent residence until 24 February 2022 *

Current correspondence address *

E-mail *

How do you prefer to be contacted by the NGO? *

Be e-mailBy messengersBy post

Documents attached to the application form:

1. A copy of the passport of a citizen of Ukraine (1,2 pages, registered address or extract on the place of residence);

2. A copy of the Tax ID certificate;

3. A copy of the internally displaced person (IDP) reference note and certificate;

4. A copy of a document issued by a foreign state confirming the status of a person in need for international protection, a migrant or a refugee (for persons currently located outside Ukraine).

A copy of the passport (national ID) of a citizen of Ukraine

A copy of the Tax ID certificate

A copy of the internally displaced person IDP reference note and certificate

A copy of a document issued by a foreign state confirming the status of a person in need for international protection, a migrant or a refugee (for persons being outside Ukraine)

I do hereby confirm that electronic copies of documents I have provided herein are true to their originals.

Date

Day

Month

Year

Personal signature *

{name-1}

1

How do you prefer to be contacted by the NGO? *

Please tick or put an X through the following options that apply to you: *

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